A Plant-Dominant Low-Protein Diet in Chronic Kidney Disease Management: A Narrative Review with Considerations for...

Chronic kidney disease (CKD) is a major global health challenge, significantly contributing to morbidity and mortality due to its strong association with cardiovascular complications, metabolic imbalances, and reduced quality of life. Among the various interventions for CKD management, nutrition therapy plays a critical role in slowing disease progression and improving patient outcomes. The Plant-Dominant Low-Protein Diet (PLADO) has emerged as a promising dietary strategy that prioritizes plant-based protein sources while restricting overall protein intake, offering potential renal, cardiovascular, and metabolic benefits. This review evaluates current evidence on the efficacy of PLADO in CKD management, analyzing its impact on renal function, cardiovascular health, and systemic inflammation. Key findings suggest that PLADO can delay CKD progression, reduce dialysis dependence, and mitigate cardiovascular risks through lower dietary acid load, increased fiber intake, and anti-inflammatory properties. Additionally, PLADO has been shown to support gut microbiota diversity and reduce uremic toxin production, offering metabolic advantages beyond kidney health. While PLADO appears nutritionally adequate, concerns remain regarding protein sufficiency, potassium management, and long-term adherence. Its successful implementation requires tailored meal planning, patient education, and regular clinical monitoring to optimize outcomes and mitigate potential risks. This review highlights the importance of integrating PLADO into CKD management as a holistic, patient-centered dietary approach, particularly in regions like Cyprus, where no studies have evaluated its applicability. By synthesizing existing research, this review provides insights for clinicians, dietitians, and researchers to further explore long-term outcomes, adherence strategies, and feasibility across diverse healthcare settings. Future studies should focus on large-scale randomized controlled trials (RCTs) to establish PLADO's role in CKD dietary guidelines and clinical practice.